Pulmonary embolism: no clear benefit from streptokinase.

Clinical bottom line (level 1b-)

  1. Patients with pulmonary embolism who received streptokinase rather than heparin were not clearly less likely to die.
Ly et al: Acta Medica Scandinavia 1978; 203: 465-470
Expires October 2003

The study

?blinded ?concealed randomised trial with intention-to-treat
Setting: university hospital, Denmark

20 patients (aged range 23 to 70 years; mean 54, ?% male) pulmonary embolism confirmed by pulmonary angiogram within 14 days of onset

Excluded if
  • symptoms for five days or more
  • minor embolism affecting less than one lobar artery
  • known or recent bleeding from urogenital tract
  • major surgery within ten days
  • recent cerebrovascular episodes
  • severe hypertension (diastolic pressure 120 mmHg or more, or hypertensive retinopathy grade 3-4)
  • severe renal or hepatic insufficiency
  • pregnancy or recent delivery
  • known malignant disease
  • aged >70


    • Control Group: (n = 10, 10 analysed): heparin for 72 hours
    Experimental Group: (n = 10, 10 analysed): streptokinase for 72 hours
    All patients received warfarin. Pulmonary angiogram was repeated at 72 hours.
    100% followed for 4 weeks

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    death 4 weeks 2
    (20.0%)    		 1
    (10.0%)    		 50%
    (-367% to 95%)    		 10.0%
    (-21.0% to 41.0%)    		 10
    (NNT = 2 to infinity;
    NNH = 5 to infinity)

  • No difference in major bleeds were noted.

    • Comments

    1. The study is too small to demonstrate small benefits of one dosing method over the other. It is unclear how angiographic changes relate to patient outcomes.

    Citation

    1. Ly B, Arnesen H, Eie H, et al: A controlled clinical trial of streptokinase and heparin in the treatment of major pulmonary embolism. Acta Medica Scandinavia 1978; 203: 465-470
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient pulmonary embolism
    Intervention or Exposure streptokinase
    Comparison heparin
    Outcome death